Efficiency of Gastro-Resistant Prednisolone Tablets?

[Katietee]

I am new to this forum, although I have had PMR for 7 years and a PMRGCAuk Member for 6 years. My "year on year" problem is tapering below 3.5 mg/pd Prednisolone. My 2.5 mg tablets are coated and I have noticed whenever I introduce these tablets to my medication, I seem to have a flare up. Dr Mackie mentioned in her recent "Adrenal Insufficiency" webinar that coated tablets take longer to digest. Has anyone else had a similar experience?

[PMRpro Ambassador]

I didn't have a problem with them but I never got as low as that!

They obviously take longer to get into the system because they have to pass all the way through the stomach before the outer coating is broken down (it is acid resistant and only breaks down in the duodenum which cames after the stomach) whereas plain pred is absorbed immediately from the stomach. The other difference is that the peak blood level achieved is lower than with plain pred but is sustained over a longer time. Maybe you need that higher peak?

You CAN get 2.5mg plain pred - one of the problems with mixing them is that the coated and non-coated tablets are absorbed at very different times. You can modify that by taking the coated pred and then the plain pred extra bit about 3 or 4 hours later and then they are absorbed about the same time. Or use a pill cutter to cut a 5mg tablet to get your 2.5mg. And see if that makes a difference.

However - Prof Dasgupta says he keeps patients at 2-3mg indefinitely which reduces the risks of relapse. If you are like several of us here, you have a long form of PMR - maybe you just need 3,5mg?

[SnazzyD]

I’ve been an enteric coated person all the way from 40mg to low doses and it has been fine but one has to bear in mind it takes 4-5 hours to reach peak effect. Have you tried a different box or brand of 2.5’s? I once had a problem with a reduction and by coincidence used a different batch of pill and hey presto I felt much better. Since then it happened with a batch of 1mg EC. In the end, because you can’t cut EC tablets for smaller numbers, I mixed both EC and non-coated. I took the EC first and then the non-coated 2-3 hours later to try to have the peaks at around the same time.

[Katietee in reply to SnazzyD]

Many thanks SnazzyD & PMRpro. Your responses have proved very interesting and I will certainly take them on board with my next reduction. I have found this forum most useful and am amazed at how many of you have suffered as I have over the past seven years. It is good to know that we are not alone.

[SnazzyD in reply to Katietee]

To add to PMRPro’s comment about lower peak. I did find in the early days when I started on uncoated Pred that I felt it ‘coming in’ more intensely than with EC Pred (so possibly higher peak) but the overall effect didn’t last as long as the EC which felt like it got me through the day.

[PMRpro Ambassador in reply to Katietee]

I also had a dodgy batch of 5mg e/c pred, the 2.5mg batch delivered at the same time was fine

[jinasc]

Sometimes the dye can be a problem, try washing it off. Makes no difference to the contents.

[Katietee in reply to jinasc]

Thank you 💕👍

[SheffieldJane]

Mine take about 6 hours to kick in. I take them at bedtime and my digestive problems all ceased. I feel good in the morning a bit achy in the evening.

[Katietee in reply to SheffieldJane]

Thank you 💕👍

[Greensleeves]

Hi Katie , I do prefer the enteric coated , I’m super lazy and take them in the early hours , with some water , and go back to sleep.

I’ve been taking for around the same time as you , we’re like the long haulers with PMRpro as our guiding light .

I have got as low as 3mg but had to increase back up to 10 mg early this year due to illness and not a flair .

The rheumatologist did suggest I’d possibly have to stay on 5mg as a maintenance dose .

Proved him wrong , for a while anyway ., I admit I was struggling on 3mg , but I’m aiming to get there again.

Take care

[Katietee in reply to Greensleeves]

👍💕